Patient satisfaction versus good health

There’s a quiet tug-of-war going on behind the scenes in medicine. Patient satisfaction is important for business, and increasingly it’s being measured and incorporated into physician scores, salaries, and employment decisions. Doctors are being employed by clinics and groups whose administrative pygmies call the final shots—and to them, the customer is always right. Maybe this isn’t always a good thing.

What administrators look for, mostly, is happy customers and quick visits. See more patients, keep ‘em happy, and you’re a successful doctor. Patients know how to complain, and believe me: those complaints do come back to the doctor.

Take antibiotics, as an example. It’s widely known that most sore throats, coughs, fevers, and runny noses do not benefit from antibiotics. Bronchitis, upper respiratory infections, and most other ailments that make kids and adults feel bad are caused by viral infections, and will not improve any quicker with any prescription. Yet: patients and parents are more happy when antibiotics are prescribed. Not all parents, of course, but many. And it takes far more time to explain why an antibiotic isn’t needed than to write the prescription. So time pressure and administrative pressure and the pressure to make patients happy all conspire against proper medical judgment.

What’s the harm? In the case of antibiotics, you’ve got a real risk of encouraging the development of antibiotic resistance. And allergic reactions, some of which are very serious. Add to that a growing risk of complications like C diff colitis and other adverse reactions. Antibiotics are not placebos. They can genuinely harm you, your children, and your community.

A more-subtle consequence: unnecessary antibiotic prescriptions reinforce the need for more antibiotics in the future. Once the expectation is created that a cough needs a pill, it’s very difficult to break the easy cycle of cough -> doctor visit -> prescription. In the short run, this pattern helps the doctor make money and helps the patient feel like they’re being taken care of. In the long run, it costs money and does far more harm than good.

It’s not just antibiotics that are the problem. Patients sometimes seem to want extra tests and procedures that have their own risks, including radiation exposure and pain. And misleading test results, which happen so often after unnecessary tests, lead to more tests and more-invasive procedures, ratcheting up the anxiety. Again, it’s easier and quicker to just order the test rather than explain why it’s not necessary. And at least the perception is that it makes patients happier.

Are happier patients necessarily healthier patients? No. A 2012 study in The Archives of Internal Medicine, called “The cost of satisfaction”, looked at a sample of about 50,000 adults and tracked health expenses, health status, and satisfaction. The happiest patients were the ones who spent the most money on health care. And they were the most likely to die.

Patient satisfaction is important, but it ought to be fostered through good communication, honest dialog, and a partnership with a primary goal of good health. Quick prescriptions, in the long run, are costing us money and lives. We need to ask: are health care economic incentives encouraging the profitable thing, or the right thing?